Microvascular and lymphatic dysfunction in HFpEF and its associated comorbidities

Ilona Cuijpers, Steven J. Simmonds, Marc van Bilsen, Elibieta Czarnowska, Arantxa Gonzalez Miqueo, Stephane Heymans, Annika R. Kuhn, Paul Mulder, Anna Ratajska, Elizabeth A. Jones*, Ebba Brakenhielm*

*Corresponding author for this work

Research output: Contribution to journal(Systematic) Review article peer-review

42 Citations (Web of Science)

Abstract

Heart failure with preserved ejection fraction (HFpEF) is a complex heterogeneous disease for which our pathophysiological understanding is still limited and specific prevention and treatment strategies are lacking. HFpEF is characterised by diastolic dysfunction and cardiac remodelling (fibrosis, inflammation, and hypertrophy). Recently, microvascular dysfunction and chronic low-grade inflammation have been proposed to participate in HFpEF development. Furthermore, several recent studies demonstrated the occurrence of generalized lymphatic dysfunction in experimental models of risk factors for HFpEF, including obesity, hypercholesterolaemia, type 2 diabetes mellitus (T2DM), hypertension, and aging. Here, we review the evidence for a combined role of coronary (micro)vascular dysfunction and lymphatic vessel alterations in mediating key pathological steps in HFpEF, including reduced cardiac perfusion, chronic low-grade inflammation, and myocardial oedema, and their impact on cardiac metabolic alterations (oxygen and nutrient supply/demand imbalance), fibrosis, and cardiomyocyte stiffness. We focus primarily on HFpEF caused by metabolic risk factors, such as obesity, T2DM, hypertension, and aging.

Original languageEnglish
Article number39
Number of pages15
JournalBasic Research in Cardiology
Volume115
Issue number4
DOIs
Publication statusPublished - 25 May 2020

Keywords

  • Heart failure with preserved ejection fraction
  • Coronary microvascular dysfunction
  • Cardiac lymphatic dysfunction
  • Inflammation
  • Myocardial fibrosis
  • Cardiac metabolism
  • PRESERVED EJECTION FRACTION
  • VENTRICULAR DIASTOLIC DYSFUNCTION
  • MYOCARDIAL SUBSTRATE METABOLISM
  • OBSTRUCTIVE PULMONARY-DISEASE
  • OXIDE SYNTHASE EXPRESSION
  • ENDOTHELIAL GROWTH-FACTOR
  • HEART-FAILURE
  • VASCULAR-PERMEABILITY
  • OXIDATIVE STRESS
  • CARDIAC LYMPHANGIOGENESIS

Cite this